Hepatobiliary Surgery Flashcards
1
Q
What are gallstones composed of?
A
Most commonly cholesterol
Also pigment
2
Q
What are the risk factors for gallstones?
A
Age >40
Female
Increases with # of pregnancies, oral contraceptive
Cholesterol - obesity, ileal disease, cirrhosis, CF, DM)
Pigment (far east) - haemolytic anaemia, bile infection
3
Q
Symptoms/Signs of Gallstones
A
Asymptomatic Dyspeptic symptoms Biliary colic Acute cholecystitis Empyema Perforation Jaundice Gallstone ileus
4
Q
What is choledocholithiasis?
A
Common bile duct stone
Often incidental finding during cholecystectomy
Can cause obstructive jaundice, acute pancreatitis, ascending cholangitis
5
Q
What investigations might be done in suspected gallstones?
A
Blood tests - LFTs (AST, ALT, ALP), amylase, lipase, WCC USS/EUS Oral cholecystography CT scan Radio-isotope scan IV cholangiography MRCP/ERCP PTC
6
Q
What are the treatments for gallstones?
A
If asymptomatic then treatment shouldn’t be given
Non-operative treatments
- dissolution
- lithotripsy
Operative
- open or mini cholecystectomy
- laparoscopic cholecystectomy +/- cholangiography (gold standard)
- NOTES cholecystectomy
- subtotal cholecystectomy
7
Q
What are the treatments for CBD stones?
A
Lap trans-cystic CBD exploration Lap exploration of CBD Open exploration of CBD ERCP Transpathic stone retrieval
